The Center for Cardio-Oncology and Innovation for Cancer Survivors

Connecticut Children’s Center for Cardio-Oncology Health and Innovation for Cancer Survivors (CHICS) instantiates a vibrant collaboration between our Center for Cancer & Blood Disorders, the Division of Diabetes & Endocrinology, Physical Therapy, Nutrition, and Health Systems Engineering, with the mission to detect and prevent heart damage in patients who have received cancer treatments that can be toxic to the heart.

What Is Cardio-Oncology?

Cardio-oncology is an emerging science and practice of the detection and management of cancer treatment-induced cardiac dysfunction, termed cardiotoxicity. Pediatric heart damage is an unfortunate byproduct of successful cancer therapy experienced by 50%+ of patients. As a result, childhood cancer survivors often experience long-term cardiovascular complications from cancer therapy, with a higher lifetime risk of heart failure. 
 

Connecticut Children’s Cardio-Oncology Clinic actively monitors cancer survivors for the earliest signs of heart damage, even before there are symptoms. Treatment at these early stages can halt, and even reverse, heart damage. Because heart complications can appear any time during/after cancer treatment, we advise survivors to keep their heart healthy through regular exercise, a heart-healthy diet, attending regular appointments, and completing surveillance tests. 

Why Is Cardio-Oncology Important?

Advances in cancer therapy have led to significantly longer cancer-free survival times over the last 40 years. Improved survivorship has highlighted the impact of cardiovascular disease in the pediatric cancer population, coupled with increasing recognition of the adverse cardiovascular effects of novel cancer therapies. We offer dedicated cardio-oncology services that span 1) pre-treatment risk stratification, 2) surveillance, 3) diagnosis, 4) monitoring of cardiotoxicity during cancer therapies, and 5) late effects screening following completion of treatment.

Innovations in Early Detection

Connecticut Children’s Cardio-Oncology team leverages existing resources with custom tools to detect cardiotoxicity early and accurately, via:

• Cardiac Magnetic Resonance Imaging (CMR) – Our cardio-oncology team uses a multimodality approach, including CMR technology, which shows “real-time heart function at high resolution.” In turn, the automation of cardiac image processing is combined with our expert medical judgment to detect the earliest heart damage, which prevention can be most effective.
• Cardio-oncology patient registry – Connecticut Children’s is continuously expanding its cardio-oncology registry of children who have been diagnosed, treated, and their clinical course thoroughly documented. This registry is data-mined to shape the care given to our patients, with an increasing scope of application to the individual nuances that our patients present.
• Risk Stratification - Our team has developed and validated a risk scoring system to better understand the risk of developing heart damage starting at the time of cancer diagnosis. This risk modeling allows stratification of patients during and after cancer therapy and a personalized approach to cardiovascular care. 

Advancing Care Through Research

The Connecticut Children’s cardio-oncology research team has over ten years of experience designing and conducting clinical and translational research specializing in early imaging and circulating biomarker approaches to detect cardiotoxicity.

Major Milestones

2011-2015: We identified early imaging biomarkers to detect cardiotoxicity in pediatric cancer patients exposed to cardiotoxic therapy. This work has allowed us to establish novel echocardiographic and cardiac magnetic resonance imaging (MRI) protocols to serially evaluate childhood cancer survivors. 

2018: We identified microRNA and protein biomarker signatures in a pilot study in patients treated for leukemia, lymphomas, and solid tumors at risk for cardiotoxicity.

2015-2019: We conducted a 16-week aerobic exercise intervention in childhood cancer survivors. This study demonstrated significant individual variation in cardiorespiratory fitness response and adherence to exercise, highlighting the need for a targeted, individualized exercise intervention approach. Children at greater risk of cardiotoxicity, appeared to benefit the most from the exercise intervention in terms of improvements in heart structure and function. 

2013-2018: Our team has worked collaboratively with experts in cancer biology, genetics/genomics, and pediatric oncology to develop a diverse mouse model of anthracycline-induced cardiotoxicity. Our team has demonstrated for the first time that anthracycline toxicity is differentially present in mice with different genetic backgrounds, in parallel with childhood cancer survivors.

2024: We are finishing a mobile application for the cardio-oncology population to provide education and motivate our patients to engage in physical activity. We were mindful to make this application fun for children and piloted several approaches to gamification. In the latest version, the mobile prioritizes connectivity to providers in-between clinic visits through coaching and chat functions.

In concert with app development, we lead a multicenter consortium of Children’s Hospitals: Imaging in Cardiac Hematology Oncology Research Consortium (ICHOR). ICHOR sets the standard of excellence for multimodality imaging in pediatric cancer patients. Together, we improve outcomes of childhood cancer survivors by early detection of heart damage with novel echo and cardiac magnetic resonance imaging tools.

Innovation Acceleration. The recent pandemic has served as a powerful reminder of the urgent need for collaborative and innovative solutions in healthcare. In 2023, our team submitted a patent to protect an innovative approach to precision cardio-oncology care using an AI-based decision support system which maps our research gains onto real-time clinical tool that scales our findings to a treatment centers worldwide.

Pediatric Cardio-Oncology Acute Cardiotoxicity Primary and Secondary Prevention Strategies Clinical Pathway